Category Archives: Uncategorised

Case 130 – the summary

In this week’s case we investigated someone with a panreactive antibody screen. In simple terms, this means that something in the patient’s plasma is reacting with all of the red cell reagents we use in our panel. This situation causes … Continue reading

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Case 130 – update 2

We have delved deeper into our 54 year old patient’s history and, as many of you guessed, he takes daratumumab for multiple myeloma. We have discussed with his clinical team and agreed to hold off transfusion until we can perform … Continue reading

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Case 130 – Update 1

Thanks for all the input thus far. We are dealing with a panreactive antibody screen (see below) in a patient not previously known to our hospital trust. The sample has been sent to NHSBT red cell immunohaematology (RCI). We are … Continue reading

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Case 130 – the beginning

It is 5pm. You are the haematology SpR and you have just congratulated yourself on clearing the blood films and aspirates to report – good job! But just as you are taking off your lab coat, a transfusion BMS pops … Continue reading

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Case 129 – Summary

This weeks case was based around Cerebral venous sinus thrombosis (CVST). Thanks for everyone’s help really lovely that so many of you contributed your thoughts. Incidence: This is a rare disorder affecting 2-4/million of the adult population a year but … Continue reading

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Case 129 – update 3

Thanks for everyone’s thoughts in line with the consensus on the feed our patient was established on split dose LMWH and her Anti Xa levels are therapeutic. She is nearing the point of discharge home and the medical team contact … Continue reading

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Case 129- update 2

Having established the patient has never had Lupus anticoagulant screening before and has no history of VTE you advise doesn’t fulfil criteria for antiphospholipid syndrome. You recommend repeat LA ratio and antibodies in 12 weeks. You explain a LP should … Continue reading

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Case 129 – update 1

Thanks for everyone’s thoughts So far we have now established the following: No Anticoagulants No ETOH excess Normal liver function No previous coagulation results available for this lady No personal history of bleeding No FHx of bleeding disorder The lab … Continue reading

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Case 129 – The beginning

You are the haematology registrar on call and you get contacted regarding a 28 year old lady who presented to the A&E department on Saturday evening. She presented with a sudden onset severe headache that had been present for 12 … Continue reading

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Case 128 – Summary!

Thank you for everyone’s contributions with case 128! We discussed a complex case of a 65 year who was critically unwell with severe pancreatitis. During her admission she developed anaemia and marked thrombocytopenia. Our discussions centred upon the potential differential … Continue reading

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Case 128 – Update 4!

Thank you for everyone’s ongoing contributions! The patient underwent further intra-abdominal surgery without significant bleeding complications following the management below: Vitamin K 10mg IV Co-trimoxazole stopped IVIg 2g/kg over 2 days Platelet transfusion (random ABO and D compatible with good … Continue reading

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Case 128 – Update 3!

I think we’re all in agreement that we currently can’t give a definitive diagnosis as is frequently the case in complex critically unwell individuals. From your responses the most likely differentials for our patient’s bi-cytopenias include the following (or combination … Continue reading

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Case 128 – Update 2!

Thank you for everyone’s ongoing contributions! We now have the outstanding results to help diagnose our patients bi-cytopenias (and old results for reference) and some additional history as requested: Her bloods from this morning are as follows: Hb 71 (several … Continue reading

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Case 128 – Update 1!

Thank you for everyone’s contributions so far! Below is the additional information you requested to help determine the cause of our 65 year old patients anaemia and marked thrombocytopenia. Her severe pancreatitis is secondary to gallstones. She has a previous … Continue reading

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Case 128 – The beginning!

You are the haematology registrar oncall and are contacted by the surgical team regarding a 65 year old woman with severe pancreatitis. The patient is critically ill. They are after some advice regarding the following FBC results: Hb 72, Plts … Continue reading

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Case 127 – the summary

Thanks for all your input this week, as we worked through the investigation and management of CML; highlighting a few areas for discussion as we went! See below summary notes on CML – mainly taken from the European Leukaemia Network … Continue reading

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Case 127 – Update 2

Our 31 year old female patient with newly diagnosed CML in chronic phase is commenced on dasatinib 100 mg OD with the aim of gaining a faster deep molecular response (DMR). 3 years later (patient is now 34)….. She has … Continue reading

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Case 127 – update 1

Our 31 year old patient has repeat bloods including a few extra. FBC confirms leucocytosis with WCC 38, and basophilia 3.8. Platelets are normal. U&Es and LFTs are normal. No organomegaly on clinical exam. Cytogenetics confirms the Ph chromosome t(9;22) … Continue reading

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Case 127 – The beginning

You are the haematology SpR reviewing routine blood films in the lab at 4pm when you come across the following FBC differential and film from a GP request. The patient is a 31 year old female. Clinical details state ‘for … Continue reading

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Case 126 – Update 3!

Thank you for everyone’s contributions so far! As advised by yourselves we have commenced our 57 year old gentleman who has newly diagnosed T-PLL on Alemtuzumab with the aim of consolidating with an allogenic stem cell transplant. He had been … Continue reading

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